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March 8, 2012

Seeing the Light Helps Parkinsonism Patient Walk

By Stacy Theobald

It began with a headache in 2007. That was followed by weakness on his left side, a slight slurring of his speech and tremors. Doctors thought Wayne Puckett, then 42 and a father of five, had suffered a stroke.

But over the next two years, the headaches persisted. Complicated migraine was the new diagnosis. But the tremors worsened and Puckett, previously an active man, began to have trouble walking.

“Our local doctors couldn’t figure out what was happening. Our family doctor said it would be best to go to Mayo Clinic,” recalls Puckett, who lives outside Orlando, Fla.

A U.S. Postal Service worker, Puckett could no longer work. He was eager for answers. In early 2010, Jay Van Gerpen, M.D., neurologist and movement disorders specialist at Mayo Clinic in Florida, diagnosed Puckett with a form of parkinsonism.

Parkinsonism is the label for a broad spectrum of movement disorders that includes Parkinson’s disease. Common symptoms are tremors and bradykinesia, the medical term for slowness of movement. Dr. Van Gerpen says patients may have difficulty with what are usually automatic movements, such as swinging an arm or taking a normal stride.

Puckett experienced both. Putting one foot in front of the other was increasingly difficult. The severity of his bradykinesia led to freezing of gait (FOG), the temporary inability to initiate movement.

“We used to walk a lot, go to the park, the mall, just spend time with each other,” says his wife, Margarita. “But it would take a lot of energy for him to take a coupleof steps.”

Dr. Van Gerpen offered a possible treatment — a new device he helped design to make walking easier.

He loaned Puckett a prototype of the Mobilaser. It attaches to a walker or cane and transmits a laser-generated beam of light that serves as a visual cue for patients with gait difficulties, particularly FOG.

“We’ve known for a long time that visual cuing can help alleviate stride reduction and cessation,” says Dr. Van Gerpen. In parkinsonism, the information to initiate a movement is not transmitted normally. “There’s a traffic jam,” he says. “By visualizing something — in this case, a line of light — you’re bypassing the congested pathway and essentially traveling a back road.”

Puckett admits he was skeptical. “I thought, ‘How is a little light going to help? I came to Mayo Clinic for you to give me a flashlight?’”

But now, he says, the Mobilaser has been a life changer. “I’m able to function more normally and go places. It’s amazing how it works.”

Adds his wife, “We’re able to go out and enjoy our surroundings.”

Dr. Van Gerpen first began working with an engineering colleague to develop a similar device in 2002. Based on positive results of a pilot study, Mayo Clinic recently started a large-scale trial to look at the long-term effects of the Mobilaser.

“Any individual with parkinsonism will eventually develop gait difficulties, so the Mobilaser has the potential to be helpful for all types of parkinsonian patients,” says Dr. Van Gerpen. “By using this device and having a more normal stride length, patients can overcome FOG and walk more naturally,” he adds.